P. VIVAX OR P. CYNOMOLGI? : PUBLIC HEALTH CHALLENGES IN DETECTION AND CONTROL MEASURES
P. vivax and P. falciparum is the most widespread human malaria, however zoonotic malaria is currently on the rise poses challenges to public health. There is limited information on other zoonotic malaria except on P. knowlesi. The first case of naturally acquired P. cynomolgi malaria in humans was reported in Terengganu, Malaysia in 2014, while this is the first case of P. cynomolgi malaria infection in humans detected in Kelantan on 11th December 2018.
The patient was a 51 years old, Malay, male, a rubber tapper from Tanah Merah experienced episode of fever on 13th November 2018 associated with chills, rigors, headache and myalgia. He sought for treatment on 20th November 2018 at hospital and diagnosed as P. vivax (2693/0 per µl blood).
Microscopic re-examination in Kota Bharu Public Health Laboratory showed characteristics of P. knowlesi (2840/31 per µl blood). Further analysis by Real Time PCR assay detected as P. vivax. A sequencing assay was performed to determine the origin of infection; the result revealed that the patient was infected with P. cynomolgi and not with P. vivax.
Control measures in human malaria involved a lot of resources as compared to zoonotic malaria. Since the initial diagnosis was P. vivax, control activities were implemented vigorously.
The zoonotic malaria cannot be ignored in view of increasing interactions between man and wild animals in the process of urbanization. Thus, the application of new diagnostic methods is necessary to distinguish between the human and zoonotic malaria species, i.e. to develop PCR with specific primers for P. cynomolgi without genotyping analysis.
Keywords: Malaria, P. cynomolgy, P.vivax, Detection, Control Measures